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,°�atue SAN JOAQUIN COUNTY <br /> GZ< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <br /> �rFOR� <br /> VECTOR CONTROL INSPECTION FORM <br /> DBA QAINSPECTJONJOATE <br /> Structure Operation Water Well L..d 5 <br /> ❑ ❑ 1. Well Construction PREMIS A6 REBS RE-00AWTION DATE <br /> ❑ ❑ 2. Cross-Connection 9 . <br /> Structure Operation Manure Management OWNER/OPERATOR PHONE <br /> ❑ ❑ 3. Spreading and Disking <br /> ❑ ❑ <�AQA94 Xe- <br /> 4. Concrete Tanks INSPECTION TYPE PROGRAM ELEMENT RECORD ID <br /> ❑ 5. Lagooning <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird Disposal <br /> ❑ ❑ 7. Burying with 2"of Cover t <br /> ❑ ❑ 8. Approved Concrete Tank <br /> ❑ ❑ 1 9. Removal from Premises ` <br /> Structure Operation Vector Control <br /> ❑ ❑ 10. Domestic FI <br /> 11. Fannia FI ff <br /> 0El12. Larvae 6mm e S <br /> 11 13. Pupae <br /> ❑ ❑ 14. Adult <br /> ❑ ❑ 15. Light Population <br /> ❑ ❑ 16. Moderate Population <br /> ❑ ❑ 17. Heavy Population <br /> Structure Operation FeedingMater 2 <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cu s or Bowls <br /> El 20. Food Storage <br /> Structure Operation Houses <br /> ❑ ❑ 21. Floors <br /> ❑ ❑ 22. Walls/Ceilings ^ 1AfZA e M P,%JLAL 4-0 <br /> ❑ ❑ 23. Cleanin Fr uenc <br /> mmmmmmmmmm [A4 <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> 2. Cross Connection <br /> Structure Operation Floors <br /> ❑ ❑ 1 3. Properly Graded to Sewer <br /> 1:1 �� <br /> ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> 7. Cleaning Frequency <br /> Structure Operation Walls <br /> ❑ ❑ 8. Smooth/Cleanable <br /> ❑ ❑ 9. Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 El 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> e <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 15. Other e <br /> Structure Operation Sewage Disposal GA <br /> ❑ ❑ 16. Septic System 1 <br /> ❑ ❑ 17. Sewer <br /> Structure Opedtion Rabies Vaccination RE EIVED BY INS P CTOR <br /> 11 El 18. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 12/04/08 <br /> Page I of_ <br />